In the USA, an estimated 1.4 million young women get potentially unnecessary pelvic exams and an estimated 1.6 million get cervical cancer screenings they may not need, researchers report in JAMA Internal Medicine. Actually, half of pelvic exams and most three-quarters of Pap tests performed among women at ages 15-20 were potentially unnecessary, exposing women to preventable harms.
Many young women associate the examination with fear, anxiety, embarrassment, discomfort and pain and some of them may forgo contraception or sexually transmitted infection (STI) screening because of psychological stress associated with these exams, which could lead to unintended pregnancies and may increase overall health risks.
Women under the age of 21 should not be screened for cervical cancer, regardless of the age of sexual initiation or other risk factors, according to the CDC guidelines set forth by the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology. Only women within this age group who are pregnant or present symptoms should consider such testing. Pap tests should only be repeated every three years following normal results. The results suggest a lag in clinical practice despite professional guidelines and recommendations – a cost that adds up to an estimated $123 million each year.
“Recent media reports have called attention to inappropriate gynecologic examinations in young women. Parents of adolescents and young women should be aware that cervical cancer screening is not recommended routinely in this age group. Pelvic exams are not necessary prior to getting most contraceptives and are often not needed to screen for sexually transmissible infections,” Dr. George F. Sawaya, Professor of Obstetrics, Gynecology and Reproductive Sciences at UCSF
The authors of the study comment that many healthcare professionals still believe that the pelvic examination is a useful tool to screen for gynecologic cancers, contrary to guideline recommendations. In the absence of any symptoms or other diseases such as being immunocompromised – like having HIV, AIDS or cancer) – a pap test is not needed prior to age 21. And, neither a pelvic exam nor a pap test is needed in order to obtain contraception, except in the case (of) an IUD; women should ask questions before consenting to these tests and consider switching providers if they’re told they can’t get birth control without a pelvic exam.
Even when women don’t think they need pelvic exams or Pap tests, they should still get annual checkups, said Dr. Melissa Simon of the Northwestern University Feinberg School of Medicine in Chicago, who wrote a commentary accompanying the study.